Wednesday, September 5, 2012

Insulin...and the start of nighttime feedings already?!


Just to keep things interesting, I started on a long-acting form of injectable insulin late last week.

I saw my OB, who blessedly came back from her two-week vacation, and she agreed with me (and the nutritionist....and some of you...) that my blood sugar was not adequately controlled - most particularly the fasting levels, which were often mid-90s, with occasional spikes into the low 100s.

So insulin it is. I started on a low dose - 2 units - last Thursday night.

And instant amazingness!! My fasting numbers were great!! Around 90. Sometimes in the high 80s! (The goal is below 95.) All my post-prandial (after eating) levels were also awesome!

Sounds wonderful, doesn't it? Enter the next major snafu...

Ketones

Ketones: they look pretty, but are not a good thing at all.
I started having ketones in my urine, which means I am breaking down fat instead of glucose for energy. The highest levels were first thing in the morning (often measuring "moderate," but once measuring "large"--akkk!), and there were small amounts present when I tested throughout the day as well.

I tried reading up on this and found that ketones + baby = badness, particularly for later intellectual functioning of said baby. Many websites referred to this information...but I couldn't find any actual research discussing exactly what we were talking about here - how severe are these cognitive problems? what levels of ketones in the urine are an issue? Is a day or two of high ketones dangerous or is it more a problem over the long haul? Who knows... because pubmed.gov failed me, or I failed to use the right search terms.

I do know that my OB has gotten very aggressive with me all of the sudden, which is both comforting and a little alarming. I saw her last Thursday. And she wanted to speak to me Saturday and then again yesterday on the phone. She also wants to talk tomorrow. And she wants to hear every glucose number throughout the day and to hear about the ketone levels. And she has upped my antenatal monitoring to twice a week. And I'm referred to an endocrinologist, who I will be meeting with this Friday.

So yeah, based on her behavior, this is clearly something not to be messed with. (Not that I'm messing with anything; I'm truly trying my darndest. I just have been trying to figure out how worried to be).

Right now I'm experimenting with adding a middle-of-the-night snack to see if it helps with the ketones.  It is pretty weird to set an alarm for the wee hours of the morning and to then get up and eat. And my heartburn...well, yeah, not so great.

Will has set an alarm that actually talks, because he was worried I'd be so disoriented with just a tone that I wouldn't remember why it was going off. So at 2am or 3am, suddenly this mechanized voice says, "It's 2am, time to get up and eat your yogurt." It's rather strange, but effective. Who knew I would be doing middle of the night feedings for the baby already?! The midnight feedings helped some the first couple of days, but not enough. I was still testing positive for ketones.

This morning, I thought I struck the magic point finally - no ketones!! But...sigh...today's fasting glucose was a smidge high again at 95. Aaargh.

I am feeling a bit exhausted and also somewhat mystified and frustrated. But I will get this under control, no matter what it takes. I will do anything to try to help this little one be as safe and snug as possible until she's ready to join us.

Mo

Click here to subscribe
Add to Google Reader or Homepage Subscribe in NewsGator Online Subscribe in Bloglines Add to My AOL

32 comments:

  1. A slow acting snack before bed, like peanut butter crackers might help you with the ketones. Try to avoid Pizza, and Bagels. Your insulin requirement may increase as your pregnancy advances, even when you are super careful with what you eat. Don't be hard on yourself, you are doing everything right and your daughter will be perfect!

    ReplyDelete
  2. Baby is hungry, Mo. She wants you to get used to no sleep, too. Clearly she is already ahead of the game in getting you to do what she wants ;)

    ReplyDelete
  3. Thanks, Anonymous. Believe me, there are no pizza or bagels here! Last night's "snack" was a bit of fruit and bunch of organic nuts. Another night it was low-fat low-sugar greek yogurt. So am definitely trying to hit the right note - lots of protein, some fat...not too many carbs.
    I tend to eat dinner not long before bed because of my long work hours, hence the middle of the night snack, rather than a before bed snack, but i hear you. if i could eat dinner at 6 or 7, the before bed snack would be great.

    ReplyDelete
  4. I was thinking about you yesterday, tried to mail you from the ipad but your details weren't stored there.

    Anyway, glad to know you're doing everything possible to manage this situation - Magpie is blessed to have such a diligent mother :)

    ReplyDelete
  5. You just can't catch a break.

    Glad your OB is being vigilant.

    Thinking of you.

    ReplyDelete
  6. Mo - you are such a champ. Hang in there, you'll figure out the right combination. Although you do this all gladly to keep the little bug healthy and safe, I'm just reminded of how much you already love her. Keep at it chica!

    ReplyDelete
  7. sweetie,
    you know you are doing EVERYTHING right, right? and that this is not about doing, it is not about trying, it is not about failing, it is simply what is right now.

    it just is.

    it is sucky and stressful, I totally get that, but it is not YOU doing/being/trying and getting it wrong.

    You're on it. Your doc is on it. Your team is on it. Everyone is doing all the right things.

    xox
    Kate

    ReplyDelete
  8. My friend had ketones and she was told to keep super hydrated... something about a low carb diet... but I don't think she was particularly low-carb! It freaked her out, but everything was fine. Drink lots of water! You're getting so close... And like Kate said, you're doing great and everything is as monitored as it can be. She'll be great!

    ReplyDelete
  9. Hi Mo,
    Did your OB suggest the middle of the night snack?
    From my understanding of diabetes, if you don't have enough insulin on board, your body will not be able to use the sugars that you eat- this is why it breaks down fat instead (forming ketones), and this is why your blood sugar can get high and you can get sugar in your urine (because without insulin, the sugar can't be used properly). Eating more won't help if the problem is that you actually need more insulin. All this to say maybe don't feel too bad about missing the 2am wake up call until you see the endocrinologist? Sorry if that is no help at all. Best wishes!

    ReplyDelete
  10. Hmmm....interesting...I don't have sugar in my urine...I have ketones. She actually thought it meant I need to be super careful about not letting too long pass in between eating (which happens when you sleep). Hopefully the endocrinologist will be able to help...but I don't think I can just let the situation go until Friday. It seems serious, so I'll stick with my doctor's advice until I see the specialist.

    ReplyDelete
  11. UGH! SO sorry you're having to deal with this! One thing after another, but I'm really glad you're taking it seriously and doing everything right, and I'm really glad your OB is right on top of it all.

    7.5 weeks to go. So very very close, and then, yeah, the midnight wakings are just gonna be happening ALL the time :) Much more fun, though, feeding a hungry baby than a not-so-hungry self! Thinking of you and hoping that with everything you're doing, you all will be able to get this under control so you can enjoy these last few weeks of pregnancy.

    ReplyDelete
  12. Coming out of lurkdom to say that I had ketones in my urine quite a bit with my daughter. Naturally I freaked out once I went online to read about it! She just started 1st grade today in an accelerated academic program (they work 2 grade levels above where they are- brag, brag). In this study, N=1 but the results are reliable because my daughter's nickname is Magpie. Sorry things can't be simple for you. It sounds like you're doing everything you can to get that baby here safely.

    ReplyDelete
  13. Anonymous,

    thanks for sharing your N=1 study : ) I like the 100% reliability rating. Awesome that your nickname for your daughter is Magpie as well, and that she's doing so well!

    Mo

    ReplyDelete
  14. Oy. I hope you can get all the numbers just right easily and quickly.

    ReplyDelete
  15. hang in there sweetie, I am glad your dr is taking things seriously and can get you the care you need. Much love to you and the growing bean!! xoxo

    ReplyDelete
  16. Hey there Mo -
    did you see this write-up on ketones during pregnancy?
    http://www.plus-size-pregnancy.org/gd/gd_ketones.htm

    I am a dietitian and from what I can tell, you may not be eating enough carbs in your late night snack. A glass of milk has a good ratio of carbs to protein. Doesn't sound like you are getting low blood sugar readings though.
    Sounds like the long-term effects of ketones on the fetus is debatable and you are proactive, so I doubt you would have any problems.
    Keep us updated on what the edocrinologist recommends.

    ReplyDelete
  17. Oh you are so close! I wish you could catch a break already. Take care. I am glad that you are being followed closely by your OB.

    ReplyDelete
  18. In addition to having GD, I Had hyperemesis With both kids. And I ALWAYS had ketones in my urine. I just could not keep up nutritionally. And my three year old is so smart it's slightly scary. And my son is also pretty smart. So. Just to put your mind at ease a little bit I hope. And I hope you're able to find the right combo to make you're ketones disappear and keep your numbers on track.

    ReplyDelete
  19. I'm so glad you're seeing an endocrinologist. Your OB rocks for being so on top of everything!

    ReplyDelete
  20. Hang in there Mo (and Magpie)-- you'll get there, and hopefully you'll get the mix of food/drugs/prayer, etc. Sending good vibes!

    ReplyDelete
  21. YOU can do this momma!!!! Hugs your way, and best of luck getting the sugar and ketones under control. I'm SO glad that you have a wonderful Dr. on your side...and of course your amazing hubs!

    ReplyDelete
  22. Wow! That's pretty aggressive! Sounds like you're in good hands.

    ReplyDelete
  23. Oh, Mo -- as others have said, it is not you or anything you are doing, it's just the challenges that (some of) our bodies face when pregnant.

    All that said I totally freaked about the ketones thing when PG with GD and was basically told, don't worry about it. There's some sort of condition diabetics can develop (ketoacidosis?) that really is horrifically dreadful, but my understanding then was that just plain ordinary ketones, in the absence of also having absurdly high blood sugar, was not cause for alarm. Standard disclaimer about my lack of medical expertise goes about here, but hopefully the endocrinologist will say the same thing that I'm 88% certain (or more) that I heard back when I was similarly situated.

    ReplyDelete
  24. Hi Mo!

    You are definitely NOT getting enough carbs in your bedtime snack. 30grams is what you need And low fat? Forget about it! You (and Magpie) want all full fat stuff! The fat (and protein) makes the carbs absorb more slowly, so you don't have to eat a snack in the middle of the night. There are some questions of whether ketones are really all that bad - the jury is still out on that one.

    Also, 2 units of insulin? The usual starting dose (at least where I trained) is 0.15units per kg; 2 units is pretty much homeopathic. :)

    ReplyDelete
  25. Shannon - thanks for your thoughts. just had some swiss cheese and crackers...will see what happens if i skip the overnight snack tonight...

    the insulin dosage is so low partially b/c I think my OB is afraid to prescribe much w/o the oversight of an endocrinologist...i agree it's almost a homeopathic dose, although I can see a difference in the glucose levels just from this...

    Mo

    ReplyDelete
  26. I want that alarm clock that talks!!! :) I think that's awesome that Will got that for you. I think you two are awesome!

    ReplyDelete
  27. This comment has been removed by a blog administrator.

    ReplyDelete
  28. sounds like a very challenging situation, Mo. I hope your consult with the endocrinologist tomorrow reassures you, and that a clear plan of action is devised. It certainly sounds like you are doing everything you can and that you are in good hands medically.
    Hang in there.

    ReplyDelete
  29. Interesting results from insulin - I have noticed that my numbers have been getting a little worse as the pregnancy has gone on and am wondering if I too will need insulin. I am trying to get in to see an endocrinologist because my OB doesn't seem comfortable with making decisions on this stuff. Unfortunately the soonest appointment I can get is Sept 17th...hopefully not too late to make a difference in this pregnancy! Good luck, I'm sure you will get this under control...it seems pretty well under control already!

    ReplyDelete
  30. Sounds like you are in great hands. Poking in to send along love and hugs and tons of best wishes to you and Will as you are just about to embark on the last month of preparations to welcome your daughter. Smooches from here!

    ReplyDelete
  31. I'm sorry you're having such a struggle with the glucose levels vs. keytones. It's amazing how everything with our bodies is such a delicate balancing act.

    On the bright side, since you're having to get up to eat during the middle of the night, hopefully that will help you adjust easier to the around-the-clock schedule Miss Magpie will start out with...

    ReplyDelete
  32. We Care Health Services
    26/18, LGF, West Patel Nagar, New Delhi, Phone: +911125889996 or +91 9716039639
    www.ivfsurrogacy.com/ivf/egg_donor_india.htm
    http://www.selectsurrogacyindia.com
    http://www.wecaresurrogacy.com

    ReplyDelete

What do YOU think?

Related Posts with Thumbnails

Popular Posts